17 Chronic Renal Failure Nursing Care Plans

March 10, 2014

Chronic renal failure (CRF) or chronic kidney disease (CKD) is the end result of a gradual, progressive loss of kidney function. The loss of function may be so slow that you do not have symptoms until your kidneys have almost stopped working.

The final stage of chronic kidney disease is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. At this point, you would need dialysis or a kidney transplant.

Nursing Care Plans

The nursing care planning goal for with chronic renal failure is to prevent further complications and supportive care. Client education is also critical as this is a chronic disease and thus requires long-term treatment.

Below are 17 nursing care plans (NCP) and nursing diagnosis for patients with chronic renal failure or chronic kidney disease:

Risk for Impaired Skin Integrity

Risk for Impaired Skin Integrity: At risk for altered epidermis and/or dermis.

Risk factors may include

Altered metabolic state, circulation (anemia with tissue ischemia), and sensation (peripheral neuropathy)
Alterations in skin turgor (edema/dehydration)
Reduced activity/immobility
Accumulation of toxins in the skin

Possibly evidenced by

Not applicable. Existence of signs and symptoms establishes an actual nursing diagnosis.

Desired Outcomes

Maintain intact skin.
Demonstrate behaviors/techniques to prevent skin breakdown/injury.

Nursing Interventions	Rationale
Inspect skin for changes in color, turgor, vascularity. Note redness, excoriation. Observe for ecchymosis, purpura.	Indicates areas of poor circulation or breakdown that may lead to decubitus formation and infection.
Monitor fluid intake and hydration of skin and mucous membranes.	Detects presence of dehydration or overhydration that affect circulation and tissue integrity at the cellular level.
Inspect dependent areas for edema. Elevate legs as indicated.	Edematous tissues are more prone to breakdown. Elevation promotes venous return, limiting venous stasis and edema formation.
Change position frequently; move patient carefully; pad bony prominences with sheepskin, elbow or heel protectors.	Decreases pressure on edematous, poorly perfused tissues to reduce ischemia.
Provide soothing skin care. Restrict use of soaps. Apply ointments or creams (lanolin, Aquaphor).	Baking soda, cornstarch baths decrease itching and are less drying than soaps. Lotions and ointments may be desired to relieve dry, cracked skin.
Keep linens dry, wrinkle-free.	Reduces dermal irritation and risk of skin breakdown.
Investigate reports of itching.	Although dialysis has largely eliminated skin problems associated with uremic frost, itching can occur because the skin is an excretory route for waste products such as phosphate crystals (associated with hyperparathyroidism in ESRD).
Recommend patient use cool, moist compresses to apply pressure (rather than scratch) pruritic areas. Keep fingernails short; encourage use of gloves during sleep if needed.	Alleviates discomfort and reduces risk of dermal injury.
Suggest wearing loose-fitting cotton garments.	Prevents direct dermal irritation and promotes evaporation of moisture on the skin.
Provide foam or flotation mattress.	Reduces prolonged pressure on tissues, which can limit cellular perfusion, potentiating ischemia and necrosis.